REPOST: Flawed Gauge for Cholesterol Risk Poses a New Challenge for Cardiologists

Cardiologists today face a dilemma as a new online calculator designed to determine a patient’s suitability for cholesterol treatment was found flawed. The New York Times’ Gina Kolata reports how physicians will face and rectify this problem.

Dr. Peter Libby, the chief of cardiovascular medicine at Brigham and Women’s Hospital, at his office in Boston in 2007. “The disease of atherosclerosis is changing before our eyes,” he said.
(Image source: nytimes.com)

This week, cardiologists learned that a new online calculator meant to help them determine a patient’s suitability for cholesterol treatment was flawed, doubling the estimated risk of heart attack or stroke for the average patient. But fixing it would not be easy, because it is based on older data, and heart attack and stroke rates today are much lower than in decades past, meaning that people are at less risk than might be expected from historical extrapolations.

Yet the outdated risk figures are the only ones available for researchers to use as assessment tools, cardiologists say, and that raises real problems for the new risk calculator, which the American Heart Association and the American College of Cardiology posted online last week as part of a radical new set of guidelines for treating high cholesterol. The guidelines, which are supposed to shape the way doctors prescribe cholesterol-lowering statins, recommend looking beyond a patient’s cholesterol readings.

“The disease of atherosclerosis is changing before our eyes,” said Dr. Peter Libby, the chief of cardiovascular medicine at Brigham and Women’s Hospital in Boston. The reasons for the changes, he said, are only partly understood.

The problem of using longitudinal health studies from previous decades to assess health risks today arose unexpectedly last weekend at the annual meeting of the American Heart Association. Two Harvard researchers, Dr. Paul M. Ridker and Dr. Nancy Cook, revealed that the new calculator released with fanfare last week exaggerated the true risk of a heart attack or stroke by an average of 100 percent. Moreover, they said, the committee that developed the calculator knew that the online tool was inaccurate yet told doctors to use it in deciding whom to treat.

The data that was used to build the calculator was 20 years old, the researchers said, and a lot has happened since then. Many fewer people have heart attacks and strokes. Those who have them do so at older ages. Women are now nearly as susceptible as men.

But there also is another issue, said Dr. H. Gilbert Welch, a medical professor at Dartmouth. The calculator, like many others used in medicine, is based on a mathematical model that assumes that risk rises in a straight line. As levels of blood pressure rise, for example, the chances of a heart attack or stroke rise in concert, the calculator assumes. In reality, Dr. Welch said, that line is far from straight.

“The model suggests that lowering systolic blood pressure from 130 to 100 is nearly as important as from 180 to 150,” he said. “I doubt there is a cardiologist in the country that believes that.”

When the guidelines were being developed, several outside reviewers, including the two Harvard researchers and Dr. Roger Blumenthal from Johns Hopkins University, pointed out that the tool seemed to exaggerate risk. The calculator, Dr. Blumenthal said, “was clearly not satisfactory.”

In response, he said, the guidelines committee added a tiebreaker for doctors to use with patients whose risk score was equivocal. Those patients could have other tests, such as a heart scan for coronary calcium, which can determine if they have plaque in their arteries, and a blood test for a protein, C.R.P., that is associated with increased risk.

But the heart groups do not plan to change or eliminate the calculator, in part because there is no good alternative. Prescribing statins is often a judgment call, doctors say, except for patients whose chance of a heart attack or stroke is extremely high, like those who have already had a heart attack or who have diabetes.

Previous treatment guidelines, which were released in 2004, also included a risk calculator, but researchers recently discovered that it, too, overestimates risk.

In fact, said Dr. Michael Blaha of Johns Hopkins, the old calculator overestimated risk much greater than the new one, mainly because it was based on data from the 1980s and from the largely white male population of Framingham, Mass.

“The new risk calculator is actually better,” Dr. Blaha said. “People did not appreciate the problems with the Framingham calculator.”

Dr. Blaha and his colleagues discovered the flaws of the calculator based on the Framingham Heart Study a couple of years ago but did not publish their results because they were waiting for the new calculator to appear. They thought any issues with the old calculator would soon be moot.

“It’s a touchy subject,” Dr. Blaha said of the old calculator’s problems.

Many doctors never used the Framingham calculator anyway, said Dr. Benjamin Ansell of the University of California, Los Angeles. Instead, they mostly offered statins to people with very high cholesterol levels, ignoring the fact that those who have lower cholesterol levels but other risk factors, like smoking or high blood pressure, often benefited.

But others used the Framingham calculator to help patients make informed decisions. Dr. Lisa Schwartz and Dr. Steven Woloshin at Dartmouth, for example, said they would show patients their risk percentage and then recalculate what it would be if they were under treatment.

Dr. Ansell said he feared that the problems with the new calculator would make doctors and patients skeptical of the new guidelines in general, even though most of the advice on how to prevent heart attacks and stroke — such as through weight control, diet, exercise and smoking cessation — has nothing to do with the calculator.

“It will be that much more challenging to implement this or subsequent guidelines,” Dr. Ansell said. “It’s a definite setback.”

Dr. Michael Pignone of the University of North Carolina said it was time to take another look at the new calculator. The guideline committee members are experts, he said, but “getting it right is really hard.”

Dr. Welch went further.

“It should be fixed,” he said. “And before we launch it on the public, we should launch it on the skeptical doctors. This matters to millions of people.”

Dr. Kamal Patel is a seasoned internist from Arlington Heights, Illinois who treats people suffering from various ailments, including cardiovascular diseases. Receive regular updates on health and wellness by subscribing to this Facebook page.

REPOST: CDC calls back furloughed scientists to handle salmonella outbreak

Despite the government shutdown, the Centers for Disease Control and prevention have called onto scientists to determine the cause of a recent salmonella outbreak, reports TIME.com’s Alexandra Sifferlin.

Only two of the Centers for Disease Control and Prevention (CDC)’s foodborne pathogen investigators were on duty during the government shutdown as a salmonella outbreak continued to sicken nearly 300 people in 18 states.

Image Source: time.com

Barbara Reynolds, the CDC’s public affairs director told TIME that 30 workers were brought back to monitor the agency’s foodborne illness network, PulseNet, which tracks cases of salmonella, E.coli, Listeria or other infections due to contaminated food. During the shutdown, only one CDC member was watching PulseNet and Dr. Thomas Frieden, the director of the CDC, told CBS News that two-thirds of the agency’s workers were on furlough.

The doctors and scientists returned the day after the U. S. Department of Agriculture issued a public health alert about salmonella contamination in raw chicken produced by three Foster Farms facilities in California. So far, 278 people have become sick since the bacterial contamination was first reported to the USDA in July; 42% of them were hospitalized.

Did the shutdown contribute to more rapid spread of the pathogen? Frieden decided that not having PulseNet properly manned was “an imminent threat to health and safety,” Reynolds said to USA Today. PulseNet serves as the hub for public health laboratories around the country to report and monitor cases of illness, and the system is critical for tracking not just the cases of infection, but also the strains of bacteria that are responsible for causing illness. So far, according to the CDC, seven strains of salmonella Heidelberg have been connected to the outbreak, many of which are resistant to commonly used antibiotics that are used to treat the infection. That’s why Frieden brought back nearly the full staff of scientists who follow foodborne pathogens, to ensure that the resistant strains are contained as quickly as possible. “We just had a harder time exchanging information because we weren’t entering data through PulseNet,” says Reynolds.

The returning CDC employees are not being paid, and although there are plans to pay some government workers retroactively, it’s unclear who will actually see a check.

Foster Farms has not recalled the chicken, but advised consumers to use a meat thermometer and cook the chicken properly, until it reaches an internal temperature of 165 degrees F.

Visit this Kamal Patel blog for more updates on medicine and health.

REPOST: Flu Shots at the Pharmacy: What You Need to Know

What does it take to get a flu shot in a pharmacy? Alexandra Sifferlin of TIME.com writes about the restrictions present in different states regarding who can receive pharmacy-administered flu shots.

Image Source: Time.com

Don’t want to wait for an appointment at your doctor’s office to get a flu shot? Retail clinics offer speedy service, but may not be allowed to vaccinate everyone.

With more ways than ever to get immunized against flu this season — two new shots now give us six different influenza vaccines — more people will be looking beyond their doctor’s office or hospital to protect themselves against the flu. Since last year, government health officials recommend that everyone six months or older be immunized against the flu. And with drugstores and supermarkets now offering walk-in flu shots, it’s easy to add vaccines to your list of errands. “We know that our pharmacy guests are in-store about once a month,” says Dr. Kevin Ronneberg, Target’s associate medical director. “The more needs that can be met from getting fresh produce to buying diapers and baby food, the more convenient it is for them.”

But different state laws regulate whether retailers can vaccinate children, so it’s worth checking on those restrictions before bringing the kids to get immunized. For instance, at retail clinics, which are generally staffed by nurse practitioners, infants as young as 18 months can get vaccinated, but if the drug store or supermarket only has a pharmacy, many states won’t allow pharmacists to immunize children without a prescription until they reach age 18 (although some states permit pharmacists to administer flu shots to children who are at least seven years old).

To provide more opportunities for people to get vaccinated, states have changed their laws and pushed for legislation that lowers the age at which children can receive vaccinations at retail centers, for not just influenza but for other childhood diseases as well. For instance, as of July, a new state law allows pharmacists in Indiana to administer vaccines to kids over age 11 without a prescription. Pennsylvania legislators are currently considering a change that would allow pharmacists to administer vaccines to children seven and older, instead of 18 and older.

If more people can get vaccinated at their convenience, public health officials hope that immunization rates, which generally hover around 30% to 40% each year, will increase. And they have reason to be optimistic. In 2008, for example, Target started a vaccine pilot program by offering flu shots in just 16 stores nationwide. After seeing significant success, the company expanded it to nearly half its pharmacy chains in 2009, and implemented the program in all 1,650 pharmacy stores by 2010. Once the program was chain-wide, Target saw a 50% increase in distributed flu shots between 2011 to 2012. At the peak of the flu season last January, the company showed a 20-fold increase in the number of distributed vaccines compared to the same period in the season previous year.

“Overwhelmingly we have had great feedback from our guests. After we rolled out the program chain-wide, we learned that 54% of people who were immunized [in Target] had no intention of getting a flu shot when they entered the store, but due to convenience and in-store messaging to create awareness, people took advantage of it,” says Ronneberg.

More “Get your flu shots here” signs have been popping up in front of neighborhood groceries and drugstores as well. This season, flu shots are offered in all Walgreens and in Healthcare Clinics in select Walgreens and Duane Reade pharmacies in New York. Customers can either schedule appointments or get their flu shot on a walk-in basis. And CVS pharmacies are also providing flu shots along with $5 ExtraBucks Rewards for use in the store as an incentive for its rewards program members.

And if your local grocery has a pharmacy, chances are it may also offer flu shots, or will in the next couple years. Kroger, one of the largest American food chain retailers (it operates under other banner names like King Soopers, Ralph’s, Fry’s and Fred Meyer), provided over 1 million flu shots last year at its pharmacies in-store, and the company anticipates similar demand this year. Depending on the region, the flu shots cost from $25-$28, and Kroger pharmacists also plan to provide the FluZone HD vaccine, a higher dose shot, for seniors. The company will also carry a limited supply of the new four-strain influenza vaccine that will be available for the first time this season.

More articles on related topics can be accessed on this Dr. Kamal Patel blog.

REPOST: Many Hearts, One Beat: Singing Syncs Up Heart Rates

Music is good for the soul in more ways than one. Time.com’s Clair Groden writes about the positive effects music has on a person’s heart rate. Read more about this finding here.

When choir members sing together, it’s not just their voices that join in harmony.

According to a study published in the journal Frontiers of Neuroscience, when members of a choir sing together, their heart rates tend to synchronize and beat as one. A team of Swedish researchers led by Björn Vickhoff discovered that this synchronicity can produce a sense of calm that is similar to the effects of yoga.

It works like this: a long nerve called the vagus nerve — Latin for “wandering” — trails down from the brain stem into the body, where it influences the heart along with a handful of other organs. Exhaling activates the vagus nerve, which slows the heart’s pulse, Vickhoff says. So, if a group’s breathing is in sync, then it makes sense that the beating of their hearts will be too.

“Singing is quite like guided breathing,” Vickhoff says. “If I would say to you, ‘Breathe in…breathe out,’ it would be quite as if you were singing a hymn in the church.”

Image source: Time.com

The researchers asked 15 high school students to sing three different song structures while their pulses were recorded. By humming a song, singing a hymn, and chanting a slow manta, the choir members varied the synchronization of their breathing. The hymn required the most rigid breathing pattern, only allowing participants to breathe at the end of musical phrases, while the hum allowed participants to breathe at will. When students sang the hymn, their heart rates were the most in harmony.

The synchronized beating isn’t just of musical interest, says Vickhoff, since the finding could inform how singing might help some people to control their breathing and heart rate more effectively. Older people and those who are under stress tend to have less variability in their heart rates, a sign of poorer heart health since their hearts are less able to adjust to the body’s changing needs. Singing, however, brings a more consistent pattern to the changes in heart rate that follows the structure of the music, according to Rickard Åström, a musician who worked on the research team.

And the unified heart rates isn’t just symbolic — it has real, emotional effects. The vagus nerve that affects the heart has a serious hand in a person’s sense of arousal or calmness. “When people are singing slow songs together, waves of calming effect go through the choir,” Vickhoff says.

The researchers are hesitant to claim any long-term health effects yet, but Vickhoff says they are already preparing another experiment that will examine the effects of the synchrony on cooperation. He and Åström both suspect that choir singers are better at coordination and are more sensitive to one another after experiencing this physical synchrony. Their hope is to see if uniting heart rates can also unite hearts.

Watch the researchers discuss the study:

Source: Nsikan Akpan on YouTube

Dr. Kamal Patel, a certified internist, runs a private practice based in Arlignton Heights, Illinois. Visit this blog for updates.

Brain surgery for OCD

An obsessive-compulsive disorder (OCD) that is too severe for psychotherapy and medication may be cured by brain surgery. This is according to a recent study published in the Journal of Neurology, Neurosurgery, & Psychiatry.

Image Source: womenshealthagency.com

In the study, 19 OCD sufferers who underwent a type of psychosurgery called bilateral capsulotomy between 1997 and 2009 were observed. Nearly half of them showed improvement and 15 percent have fully recovered seven years later.

LiveScience reports that psychosurgery—brain surgery for mental disorders—has been performed since the 1930s but has declined during the introduction of psychiatric medications. The new advancements in brain imaging technology, however, have revived the practice by helping doctors select the surgery target more carefully.

Image Source: psychiatricnews.org

Prior to the recognition of bilateral capsulotomy as a treatment for OCD, doctors have also performed deep brain stimulation. Unlike capsulotomy, which permanently damages brain tissue, deep brain stimulation implant is reversible. However, those who have undergone the procedure face risks of infection and erosion of the device through the skin. It is up to the patients then to choose what type of surgery to undergo since both options are not free of complications.

OCD is defined by the National Institute of Mental Health as an anxiety disorder that causes individuals to repeat things over and over in an act to relieve themselves of distress. When their rituals get in the way of daily life, it becomes a compulsion. While normal people repeat or re-check an activity for assurance, OCD sufferers do not have control over what they are doing.

Image Source: topnews.in

Dr. Kamal Patel, an internist practicing in Arlington Heights, IL, is an expert in the diagnoses and treatment of adult diseases, like OCD. Follow this Twitter page to keep abreast of the latest happenings in health and medical science.

Of grief and loss: Adults in the time of bereavement

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When they lose someone special due to an accident or a disease or any unfortunate event, some adult Americans choose to grieve privately than publicly, something that is dangerous to their well-being.

Grief, a natural response to loss, is an emotional suffering a person feels after losing someone or something he loves. It is also an emotion that is detrimental to adults, because, unlike children, they already have the capacity to understand the gravity of the experienced loss.

Image Source: nssousa.org

Although adults have the understanding they need to cope with grieving, they also have the tendency to over-dwell on it. That said, what a grieving adult needs is a person who knows him well. Spending time with friends and family will keep the grieving person from spiraling down into depression, and will help him gradually accept the loss.

In some cases, joining a support group, composed of different people who experience the same problem, can also help. When the grieving is too much to take, it is advisable to talk to a therapist or a grief counselor. Health professionals have their own special way of dealing with patients having problems concerning grief, since they work thorough intense emotions and overcome obstacles to a person’s grieving.

Image Source: life.drprem.com

Losing a loved one is difficult, but going through the whole process of accepting the loss can be more difficult for some. In times of bereavement, individuals can always seek the help of family, friends, and medical professionals.  


An internist and multi-linguist, Dr. Kamal Patel specializes in treating adult diseases. Discover more about his practice at this Twitter page.

A rare form of sleepwalking

There is pleasure in making love in the middle of the night, but there is none when one realizes that he’s the only one awake in that passionate feat.

Image source:  foxnews.com

Though it has been regarded as a mere sexual behavior in sleep in a 1996 research done by Sleep Research, sexsomnia—or a condition in which the person engages in sexual acts while he’s asleep——has had its precise definition broadened after the Canadian Journal of Psychiatry redefined it in 2003 as a subtype of parasomnia and not a kind of somnambulism.

Image source: amaracharles.wordpress.com

What makes sexsomnia different from other sleep disorders is that it involves another individual. In the perspective of the sexsomniac, he would end up waking in the middle of his sleep while performing a sexual act with another person. This manifestation made many experts believe that this sleeping disorder happens while the person is dreaming and unconscious, which means that a person can only suffer from sexsomnia if he has experienced sex—or “anything sexual” for that matter—be it direct (an actual sexual intercourse) or not (through heard stories and watched movies).

The latter, however, creates a more alarming fact: now that the younger generation is more exposed than at any other time in history to the explicit contents that are available on the Web, there’s a possibility that sexsomnia would soon blight the innocent population of the youth.

Image source: newparent.com

Dr. Kamal Patel is a seasoned internist at the Northwest Medical Clinic in Arlington Heights, Illinois who has expertise in treating people suffering from different kinds of sleep disorder. To learn more about his specializations, visit this Twitter page.

On adult vaccination: Grown-ups don't like getting shots

The recent flu epidemic has motivated many Americans to get flu shots to protect and maintain their well-being. 44 US states have already declared widespread flu outbreak, and the US Centers for Disease Control and Prevention (CDC) also reported that the percentage of Americans going to the hospital has doubled within the past month. While the flu vaccine doesn’t guarantee a flu-free effect, people see it as the best option for flu prevention.

Image source: slate.com

The number of people getting flu shots significantly increased, but there are only few adults who get non-flu vaccination. CDC says that the vaccination coverage levels in adults are “unacceptably low” for pneumonia, cervical cancer, and hepatitis. The coverage for the Tdap (tetanus, diphtheria and pertussis) and HPV (human papilloma virus) vaccines have only showed modest gains, too.

Image source: chicagotribune.com

The low rate of American adults getting non-flu vaccination is believed to be caused by their confusion about what vaccines to get, the vaccination schedules, and their individual risk to vaccines.

To solve this problem, public health workers are encouraged to be intent on influencing adults to get immunizations. The CDC website has also provided an online assessment to help people determine if they are due for any immunizations.

For their part, adults should ask their healthcare providers if they are due for any shots. They can also visit health centers or consult their doctors for immunization vaccines.

Image source: foxnews.com

For adults looking for more information on diseases and health care, this Dr. Kamal Patel Twitter page is a good source of information.

REPOST: Society of General Internal Medicine Launches New Website on Bridgeline Digital's iAPPS Platform

This feature was taken from Yahoo! Finance and appeared in the website on December 11, 2012. The article primarily discusses the Society of General Internal Medicine's launching of its newest set of online portals through Bridgeline Digital's iAPPS platform.

Bridgeline Digital, Inc. (BLIN), The Digital Engagement Company(TM), today announced the launch of a new website for The Society of General Internal Medicine (SGIM) at SGIM.org. SGIM joins a growing number of healthcare organizations including American Dental Association, the American Academy of Dermatology, and the Maryland Hospital Association to select Bridgeline Digital's iAPPS platform to power its next generation websites.

Bridgeline Digital redeveloped SGIM's main website and consolidated and enhanced two microsites run by SGIM affiliate groups: the Association of Chiefs in General Internal Medicine (ACLGIM), and SGIM's Journal of General Internal Medicine (JGIM). The SGIM main site and the new micro site for the ACLGIM are now live and the new microsite for the JGIM is in development and expected to launch in early 2013.

Bridgeline's development team added a dynamic Social Footer to SGIM's primary website which incorporates interaction and content from LinkedIn, Twitter, and Facebook that enables increased engagement and understanding of their website users. Bridgeline also added a comprehensive customization feature allowing SGIM to change microsite-based templates with ease to respond to changes in their marketing strategy.

SGIM's new website also features innovative functionality around internal search and data recovery in its Resource Library. Leveraging iAPPS' out-of-the-box integration with Perceptive Software Enterprise Search (formerly ISYS Search), the new site leverages search component catalogs natively within the iAPPS framework and indexes all media types, including content within PDF files vastly improving the ease and speed in which users can access relevant content.

"Bridgeline Digital was extremely innovative with their services," said Francine Jetton, Society of General Medicine's Director of Communications. "The Social Footer strengthens SGIM's presence and activity across social media outposts, which is a key component of our marketing strategy and critical for our business success going forward."

Dr. Kamal Patel is a renowned internist based in Arlington Heights, Illinois. He has extensive resources to develop medical technologies to combat adult diseases. Read updates on this Facebook page to know more about him and his field of expertise.